*
Required
SCORE Application
What school district do you live in?
*
required
Please Select…
Big Pasture
Cache
Chattanooga
Elgin
Fletcher
Geronimo
Indiahoma
Lawton
Sterling
Other
What school did you attend last?
*
required
Please Select…
Big Pasture High School
Cache High School
Chattanooga High School
Eisenhower High School
Elgin High School
Fletcher High School
Gateway -LPS
Geronimo High School
Homeschooled or Virtual Academy
Indiahoma High School
Lawton High School
MacArthur High School
SCORE - Great Plains Technology Center
Sterling High School
Other
Current Grade Level
*
required
Please Select…
9th
10th
11th
12th
Name
First
*
required
Middle
*
required
If none, put N/A.
Last
*
required
Address
Street Address
*
required
Address Line 2
City
*
required
State
*
required
Zip
*
required
Student Phone
*
required
Parent/Legal Guardian's Information
First Name
*
required
Last Name
*
required
Parent/Guardian Phone
*
required
Parent/Guardian's Work Phone
*
required
Emergency Contact Information
First Name
*
required
Last Name
*
required
Emergency Contact's Relationship
*
required
Relationship​
Emergency Contact Phone
*
required
Please make sure all phone numbers listed are current and if numbers change see one of the secretaries in the main office.
Personal Background Information
Are you between the ages of 16 and 21?*
Yes
No
Why are you interested in attending Great Plains Technology Center and SCORE?
*
required
Are you aware that no transportation is provided by Great Plains Technology Center for the SCORE program?*
Yes
No
Do you have reliable transportation to get you to and from school?*
Yes
No
(In some cases, SCORE high school students may ride public school buses.)
Which of the following (if any) contributed to your leaving school?*
Lack of interest
Behavioral difficulty
Academic difficulty
Non-attendance
Marriage
Pregnancy
Employment
Physical illness
Needed at home
Other reason
Please Explain:
Signature Agreement*
By selecting this box and typing your name below, you are signing this agreement electronically. You agree your electronic signature is the same as a handwritten signature for the purposes of validity, enforceability, and admissibility.
Electronic Signature
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required
Type your full name.
Date
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required
(mm/dd/yyyy)
Please send a confirmation email to the address below: